Alcohol dehydrogenase inhibitor
Blocks the first step of toxic-alcohol metabolism
- Prevents methanol/ethylene glycol from being activated to their toxic acids — the antidote mechanism
- The parent alcohols are far less toxic than their metabolites
- Given early, dialysis may be avoided
- Competitive ADH inhibition stops methanol → formic acid and ethylene glycol → oxalate
- The PARENT alcohols are barely toxic; the metabolites blind (formate) and destroy kidneys (oxalate)
- ➔ fomepizole (ANTIZOL) — 4-methylpyrazole; first-line antidote
- Ethanol works the same way (ADH affinity), used when fomepizole is unavailable
- Buy time for hemodialysis; give until osmolar gap and acidosis clear
Drugs with this mechanism (1)
- Fomepizole — Alcohol-dehydrogenase inhibitor and preferred antidote for methanol or ethylene-glycol poisoning.
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